Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment
In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must b...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Respiratory Medicine Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007122001757 |
| _version_ | 1797987285627568128 |
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| author | Takae Okuno Kazuhisa Nakashima Yuki Mitarai Masatoshi Kataoka Hiroshi Tobita Mamiko Nagase Takeshi Isobe Yukari Tsubata |
| author_facet | Takae Okuno Kazuhisa Nakashima Yuki Mitarai Masatoshi Kataoka Hiroshi Tobita Mamiko Nagase Takeshi Isobe Yukari Tsubata |
| author_sort | Takae Okuno |
| collection | DOAJ |
| description | In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must be discontinued. Since it may be difficult to determine the exact drug causing the hepatitis, liver biopsy may help identify this. We report the case of a patient diagnosed with immune-related adverse event hepatitis from liver biopsy and clinical course.A 45-year-old man with lung adenocarcinoma (stage IV, cT4N3M1c) negative for driver gene mutation was treated with carboplatin (CBDCA), pemetrexed (PEM), and pembrolizumab. Elevated blood aspartate aminotransferase and alanine aminotransferase levels after chemotherapy indicated hepatitis induced by cytotoxic anticancer agents and ICIs. As autoimmune hepatitis was also suspected, liver biopsy was performed and the findings suggested ICI-induced hepatitis. Pembrolizumab was discontinued and CBDCA/PEM was resumed, following which, the primary lesion shrank. When drug-induced hepatitis is suspected, clinicians should actively perform liver biopsy to confirm the diagnosis, so that appropriate therapeutic regimen can be administered. |
| first_indexed | 2024-04-11T07:46:32Z |
| format | Article |
| id | doaj.art-bde3880c5e774956ac6b5d9383617e18 |
| institution | Directory Open Access Journal |
| issn | 2213-0071 |
| language | English |
| last_indexed | 2024-04-11T07:46:32Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj.art-bde3880c5e774956ac6b5d9383617e182022-12-22T04:36:18ZengElsevierRespiratory Medicine Case Reports2213-00712022-01-0140101753Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatmentTakae Okuno0Kazuhisa Nakashima1Yuki Mitarai2Masatoshi Kataoka3Hiroshi Tobita4Mamiko Nagase5Takeshi Isobe6Yukari Tsubata7Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, JapanDepartment of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, JapanDepartment of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, JapanDepartment of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, JapanDepartment of Gastroenterology and Hepatology, Shimane University Faculty of Medicine, JapanDepartment of Organ Pathology, Shimane University Faculty of Medicine, JapanDepartment of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, JapanDepartment of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Japan; Corresponding author. Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan.In recent years, the combination of platinum-based chemotherapy and immune checkpoint inhibitors (ICIs) has become the standard treatment for patients with lung cancer. Hepatitis is one of the common toxicities following ICI/chemotherapy. When drug-induced hepatitis occurs, the suspected drug must be discontinued. Since it may be difficult to determine the exact drug causing the hepatitis, liver biopsy may help identify this. We report the case of a patient diagnosed with immune-related adverse event hepatitis from liver biopsy and clinical course.A 45-year-old man with lung adenocarcinoma (stage IV, cT4N3M1c) negative for driver gene mutation was treated with carboplatin (CBDCA), pemetrexed (PEM), and pembrolizumab. Elevated blood aspartate aminotransferase and alanine aminotransferase levels after chemotherapy indicated hepatitis induced by cytotoxic anticancer agents and ICIs. As autoimmune hepatitis was also suspected, liver biopsy was performed and the findings suggested ICI-induced hepatitis. Pembrolizumab was discontinued and CBDCA/PEM was resumed, following which, the primary lesion shrank. When drug-induced hepatitis is suspected, clinicians should actively perform liver biopsy to confirm the diagnosis, so that appropriate therapeutic regimen can be administered.http://www.sciencedirect.com/science/article/pii/S2213007122001757Non-small cell lung cancerImmune checkpoint inhibitorImmune-related adverse eventsHepatitisLiver biopsy |
| spellingShingle | Takae Okuno Kazuhisa Nakashima Yuki Mitarai Masatoshi Kataoka Hiroshi Tobita Mamiko Nagase Takeshi Isobe Yukari Tsubata Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment Respiratory Medicine Case Reports Non-small cell lung cancer Immune checkpoint inhibitor Immune-related adverse events Hepatitis Liver biopsy |
| title | Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment |
| title_full | Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment |
| title_fullStr | Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment |
| title_full_unstemmed | Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment |
| title_short | Immune checkpoint inhibitor (ICI)-induced hepatitis diagnosed by liver biopsy followed by ICI-free chemotherapy leading to therapeutic effect: A case of lung cancer treatment |
| title_sort | immune checkpoint inhibitor ici induced hepatitis diagnosed by liver biopsy followed by ici free chemotherapy leading to therapeutic effect a case of lung cancer treatment |
| topic | Non-small cell lung cancer Immune checkpoint inhibitor Immune-related adverse events Hepatitis Liver biopsy |
| url | http://www.sciencedirect.com/science/article/pii/S2213007122001757 |
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